Acute heart failure in patients with acute myocardial infarction treated with primary percutaneous coronary intervention

Background: Scanty data exist about the relation between acute heart failure (HF) and acute myocardial infarction (AMI). Aim: To assess the impact of HF on outcome in AMI patients treated with primary percutaneous coronary intervention (PCI). Methods and results: Out of 2089 AMI patients, 82% did not present HF, 17% presented HF on admission and 1% developed HF after hospitalisation. Predictors of HF on admission were age, diabetes, prior MI, time delay to admission, anterior location, and TIMI grade 0-1 in the culprit vessel. Predictors of HF during hospitalisation were age and peak creatine kinase. The 1- and 6-month mortalities were 1.1% and 2.2%, 8% and 12%, 26% and 33% in patients without HF, with HF on admission and after hospitalisation, respectively. The risk of death was higher in patients with HF than in patients without HF (HR 3.47), as well as in patients with HF after admission (HR 5.19) than in patients with HF on admission (HR 2.44). Conclusions: In a primary PCI setting, the incidence of HF on hospital admission remains high, but mortality is lower when compared with historical patient series. Primary PCI may prevent the development of HF during hospitalisation; however, when HF develops, the prognosis remains severe. (c) 2008 Published by Elsevier B. V. on behalf of European Society of Cardiology.